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Evaluating Neoadjuvant Chemotherapy Treatment Response

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So now we're gonna look at a different area,

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a different clinical indication, which,

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which is using contrast-enhanced mammography

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to evaluate for neoadjuvant chemotherapy.

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So this was a patient who had a grade three, um, HER2+

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breast cancer and had a positive lymph node.

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You can see the cancer marked by the thicker arrow

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and the node, uh, marked by the longer, thinner arrow.

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And so, this is an example where the contrast mammo was

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used to see how the patient responded to treatment.

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So these are the recombined images initially

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before treatment, which show you what

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you would expect — the cancer and the node.

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And this is what we see after treatment.

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So, um, the images in yellow are the pre-treatment

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images, and the images with the white annotations are

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post-treatment. And so on our low energy images, we can

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see that it looks like there's improvement, but you

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probably remember from other, uh, talks on neoadjuvant

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therapy where typically we categorize things as:

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total response, no response, and a partial

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response, which has to be at least 30%.

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And so the question is, where does this fall in?

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Is this a partial response?

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Is this a total response?

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So we get our recombined images, which give us

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a much better sense as to how this patient has

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responded to the chemotherapeutic treatment.

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So there was a meta-analysis in 2023 — so recent —

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that showed that the sensitivity for, um,

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evaluating neoadjuvant chemotherapy treatment

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response was actually better for CEM over MRI.

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And it showed that the specificity was

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actually a little bit worse — 68% to MRI.

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But they're always kind of balancing,

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you know, these, these two imaging

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exams are always kind of teetering.

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Like one is a little bit better,

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one is a little bit worse.

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Um, Bernardi and colleagues in 2022 showed that

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the CEM size measurements correlate highly with

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the size measurements on MRI. And studies show

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variable rates of over- and underestimates for

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contrast mammo and MRI, but always very similar.

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So it's hard to say,

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do they overestimate it by a few millimeters?

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Do they underestimate it by a few millimeters?

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I don't know what the exact answer for

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this is because the data is kind of,

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like I said, very variable. But the take-home point

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is that these two imaging exams are very similar,

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and that we can use contrast-enhanced mammography

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as an alternative to MRI for neoadjuvant and

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chemotherapy treatment response, especially — for sure —

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if you don't have MRI, for sure.

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For sure.

Report

Faculty

Jordana Phillips, MD

Division Chief of Breast Imaging, Boston Medical Center

Boston Medical Center

Tags

Oncologic Imaging

Neoplastic

Mammography

Diagnosis & Staging

Breast

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